Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Japan.
Spine (Phila Pa 1976). 2022 Aug 1;47(15):1077-1083. doi: 10.1097/BRS.0000000000004359. Epub 2022 Jul 15.
A prospective multicenter study.
This study aims to evaluate patient-reported outcomes using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and clarify clinical factors that affect the therapeutic effects for patients with cervical ossification of the posterior longitudinal ligament (OPLL).
Although previous studies identified factors that affected the surgical outcomes, their assessment was mainly based on the Japanese Orthopedic Association score, which only includes neurological function. Investigating this pathology through multiple functions and quality of life (QOL) is pivotal to understanding the comprehensive clinical pictures of the cervical OPLL and its therapeutic outcomes.
This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of the patients, 168 received laminoplasties and fully completed questionnaires. Demographic information, imaging findings, and clinical outcomes were collected. Patients were grouped according to effective or ineffective surgical outcomes as defined by the JOACMEQ using logistic regression analyses.
Laminoplasty resulted in functional improvement in the cervical spine and upper extremity around 40% of the patients, while QOL showed only 21.4% ( P <0.01). Multivariable analyses revealed that younger age and a postoperative decrease in arm or hand pain were correlated with significantly improved function of the upper extremities. A reduction in lower limb pain favorably affected the postoperative lower extremity function. A postoperative reduction in upper extremity pain enhanced the QOL recovery.
Surgeons should recognize the diversity of surgical outcomes after laminoplasty and understand the necessity of pain management even after the surgery to enhance bodily functions and QOL in patients with cervical OPLL.
前瞻性多中心研究。
本研究旨在使用日本骨科协会颈椎病评估问卷（JOACMEQ）评估患者报告的结果，并阐明影响颈椎后纵韧带骨化（OPLL）患者治疗效果的临床因素。
尽管先前的研究确定了影响手术结果的因素，但它们的评估主要基于日本骨科协会评分，该评分仅包括神经功能。通过多种功能和生活质量（QOL）来研究这种病理学对于了解颈椎 OPLL 的全面临床情况及其治疗效果至关重要。
本研究由日本脊柱韧带骨化多中心研究组织进行。2014 年至 2017 年，来自 28 个机构的 478 例由颈椎 OPLL 引起的脊髓病患者前瞻性登记，并随访 2 年。其中，168 例接受了椎板成形术并完全完成了问卷。收集了人口统计学信息、影像学发现和临床结果。根据 JOACMEQ 将患者分为手术效果有效或无效的两组，并使用逻辑回归分析进行分析。
椎板成形术使大约 40%的患者颈椎和上肢功能得到改善，而 QOL 仅显示 21.4%（P<0.01）。多变量分析显示，年龄较小和术后手臂或手部疼痛减轻与上肢功能显著改善相关。下肢疼痛减轻有利于术后下肢功能的改善。上肢疼痛减轻可促进 QOL 的恢复。
外科医生应认识到椎板成形术后手术效果的多样性，并理解即使在手术后也需要进行疼痛管理，以增强颈椎 OPLL 患者的身体功能和 QOL。
